Provider Demographics
NPI:1689407538
Name:BROOKS, RACHELLE LATRICE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:LATRICE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:RACHELLE
Other - Middle Name:LATRICE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 932958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:240 NEW BYHALIA RD
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3716
Practice Address - Country:US
Practice Address - Phone:901-853-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-24
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN278193163W00000X
MARN2359082163W00000X
WARN61037051163W00000X
MS902777163W00000X
MO2020035389163W00000X
TN36964363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse